Manager Care Coordinator/Disease Management

We're looking for a Manager of Care Coordination/Disease Management, someone who's ready to grow with our company. In this position, you'll manage staff who provide case management services to Health Plan members, ensure the needs of members and their families are met while meeting or exceeding Human Services Commission (HHSC) contract/Uniform Managed Care Manual (UMMC) and National Committee for Quality Assurance (NCQA) requirements. You'll also implement internal policies and identify areas of opportunity to support or respond to the strategic goals of our company. Think you've got what it takes? Job Duties & Responsibilities Provides coverage as needed to meet program goals Participates in interdepartmental groups to represent case management needs in different aspects of our Health Plan, including but not limited to utilization management, provider relations, operations, finance, quality improvement and member services Serves as a liaison with community agencies and other groups and organizations which impact Medicaid health services Maintains current knowledge and contacts with alternate sites for appropriate health care delivery within the community and the state needed for pediatric population Ensures care team communicates the outcomes of assessment and discusses identification of member needs, ensuring appropriate level of care and updates to the level of care during changes in condition including admissions, illness and ensures continuity of care Notifies members and providers of approved and denied services verbally and through written correspondence in accordance with written policy and procedure Assists in identifying members in need of case management through clinical referral, staff referrals, consultation predictive modeling, PCP, parents, and other internal Health Plan areas Comprehensively assesses member's psychosocial, environmental, discharge planning needs, readiness to change, understanding of resources, and financial status Ensures that NCQA requirements specific to your department are fulfilled, but also understand the linkage between your departments requirements and those of the integrated delivery system Skills & Requirements Bachelor's degree in nursing required RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required 2 years of managed care experience required and 5 years of experience in population health, community public health, ambulatory care, or healthcare administration required ABOUT US Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.